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Adverse Drug Events in Older Adults

Most medications responsible for emergency adverse drug events are not included in the Beers criteria.

The Beers criteria are a consensus-based list of more than 40 medications or medication categories that are ineffective, unnecessarily risky, or potentially inappropriate for use in adults aged 65 and older (e.g., diphenhydramine, diazepam, and indomethacin). Researchers used data from national ambulatory databases and an adverse drug event surveillance system to estimate rates of emergency department (ED) visits for adverse drug events that were attributed by a treating physician not only to Beers criteria medications, but also to other medications.

An estimated 177,500 ED visits for adverse drug events by patients aged 65 and older occurred annually in 2004 and 2005. Only 9% of events involved Beers criteria medications; the other 91% involved non-Beers medications. Fourteen medications were implicated in 1% or more of adverse drug event visits; digoxin was the only one of these drugs on the Beers list. Three classes of medications accounted for 48% of visits: oral anticoagulants and antiplatelet agents, antidiabetic agents, and narrow therapeutic index agents (e.g., digoxin, phenytoin). The most commonly implicated medications were warfarin, insulin, aspirin, clopidogrel, and digoxin.

Comment: Apparently the vast majority of emergency visits for adverse drug events involve medications that do not meet inappropriate use criteria that are applied widely for assessment of quality of care. These results suggest that more attention to the appropriate use of potentially beneficial medications (and not just to medications considered inappropriate) is needed to prevent most adverse drug events.

— Richard Saitz, MD, MPH, FACP, FASAM

Published in Journal Watch General Medicine January 2, 2008

Citation(s):

Budnitz DS et al. Medication use leading to emergency department visits for adverse drug events in older adults. Ann Intern Med 2007 Dec 4; 147:755.

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